JCPSLP Vol 14 No 1 2012

Case study profiles In this section we present checklist profiles of two parent– child pairs from a larger research project to illustrate its use for clinical decision-making. These cases were chosen because they did not progress according to published benchmarks (Rousseau, Packman, Onslow, Harrison, & Jones, 2007) and it is possible that lack of fidelity in the application of treatment might have been a contributing factor. Upon completion of Stage 1 or withdrawal from the study, the checklist was completed for weekly beyond-clinic recordings across the course of treatment. Reported here are the modal scores on the checklist for all recordings across treatment. These are displayed in Table 1. The clinical implications of items designated as “sometimes” or “almost never” will be discussed. It is arguable that if this checklist had been available and used early in treatment for these two families, some of the issues with treatment delivery could have been dealt with in a timely fashion, prompting a much more successful and expedient outcome for them. This boy was 2 years 11 months old when treatment began. His average pre-treatment severity was 7.3 %SS from within- and beyond-clinic conversations with an average severity rating of 4 given within- and beyond-clinic by his mother, the speech pathologist, and a researcher. The within-clinic ratings were collected as part of routine clinical treatment. The beyond-clinic ratings were calculated from two 10 minute recordings, one with a familiar adult Case Study 1 Demographics

and one with an unfamiliar adult, collected for the research project. Additionally, a typical rating for the previous week was given by the mother as part of the research data collection. He took 27 sessions and 36 weeks to complete Stage 1. At entry to Stage 2 his stuttering frequency within the clinic was 0.5 %SS and his speech pathologist gave a severity rating of 1. This concurred with his mother’s rating of 1 as typical of his severity for the week preceding Stage 2 entry. Checklist profile The majority of items, 17 of 21 (81%), received a modal score of 3, “most of the time.” Treatment duration was within the recommended 10 to 15 minutes for the majority of the weekly recordings of beyond-clinic treatment in structured conversations. If using the checklist to aid clinical decision-making, the speech pathologist would have encouraged the mother to continue administering these treatment components in that fashion. However, Item 13, non-invasive parent verbal contingencies appropriate to the conversation , received a modal score of 1, “almost never.” Additionally, items receiving a score of 2 “sometimes” included Item 7, variety in parent verbal contingency phrasing and Item 8, a range of parent verbal contingency types used . The mother provided parent verbal contingencies at a rate that appeared invasive for the conversation. She praised every stutter-free utterance her son produced and this, combined with her lack of variation in phrasing and range of contingency types used, produced repetitive and monotonous feedback which was likely to rapidly lose any reinforcing properties. If that had been detected, the

Table 1. Modal scores for the two case studies Checklist item

Case 1 Case 2

1. Parent verbal contingencies provided immediately after response

2 3 3

2 3 3 3 3 3 1 2 3 3 3 3 3 3 2 3 3 3 2

2. Parent verbal contingencies provided with a neutral, natural, non-punitive tone

3. Parent verbal contingencies provided by the trained parent only

4. Parent verbal contingencies applied to conversations rather than speech known to induce fluency, such as counting 3

5. Parent verbal contingencies clearly for stutter-free or stuttered speech and not another child behaviour

3

6. Parent verbal contingencies accurate for child response (e.g., parent verbal contingencies for stutter-free speech not given for stuttering) 3

7. Variety of parent verbal contingency phrasing 8. A range of parent verbal contingency types used

2 2 3 3 3 3 1 3 3 3 3 3 3

9. Only Lidcombe Program guide parent verbal contingencies used

10. More parent verbal contingencies for stutter-free than stuttered speech 11. Child appears to enjoy parent verbal contingencies for stutter-free speech 12. Parent verbal contingencies for stuttered speech are not received negatively by the child

13. Parent verbal contingencies non-invasive to the conversation 14. Treatment conversation is a positive experience for child

15. Primary focus of conversation is stuttering treatment, not correct pronunciation or the rules of the game

16. Parent and child engaged and focused on treatment, not distracted by others 17. Therapy given during an everyday activity a child and parent would conduct together

18. Activity results in an interactive conversation

19. Child stutters only occasionally

20. When the child responses range in length, parent verbal contingencies are primarily given for longer rather than shorter stutter-free utterances

3 3

2

21. Treatment duration 10–15 minutes (or as directed by clinician) 1 For Items 1 to 20, 3 = most of the time, 2 = sometimes, 1 = almost never. For Item 21, 3 = yes, 2 = no – shorter, 1 = no – longer.

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JCPSLP Volume 14, Number 1 2012

Journal of Clinical Practice in Speech-Language Pathology